Disability Insurer Profiles #7: MetLife
Metropolitan Life Insurance Company, or MetLife, is one of the largest insurance providers in the world. Originally founded in 1868, the company now employees almost 50,000 people, services over forty national markets, and reported $22.925 billion in revenue from premiums alone in 2017.[1] MetLife discontinued the sale of individual disability policies in March 2017 and now only sells group policies.[2]
If you have a MetLife policy and are considering filing a claim, it is important to recognize that a disability claim is an ongoing evaluation. Even if your claim is initially approved, the disability company has a right under most disability policies to continuously re-assess whether you remain “totally disabled.” Given the amount of money on the line, MetLife (like other insurance companies) will typically review its claims periodically, to see if there is any basis to terminate benefits. This can be problematic for physicians and dentists who are not anticipating this degree of ongoing scrutiny, and have not taken the time to understand how their policy works.
One common mistake that physicians and dentists make is going back to work in a new job, without understanding how that will impact their claim. For example, in Abena v. MetLife[3], a dentist filed a disability claim due to pain and numbness in his hands and arms. MetLife initially approved his claim, but roughly a year after his disability date, MetLife learned that the dentist has started a new job as the director of the dental clinic at a university.
MetLife investigated the new position, and determined that the job responsibilities of the clinic director at that particular university included providing direct patient care, which MetLife maintained was inconsistent with the dentist’s disability claim. Next, MetLife hired an investigator to conduct surveillance of the dentist over a three day period, and concluded that the dentist was able to engage in a variety of daily activities and tasks without any apparent limitations or problems. Finally, MetLife hired a doctor to review the dentist’s medical records, and the consultant doctor determined that the dentist had no physical impairments that would preclude him from practicing dentistry.
At this point, MetLife terminated the dentist’s claim. The dentist appealed, but MetLife upheld its decision on appeal. The dentist and his attorney eventually sued MetLife, but did not file the lawsuit until three years after the MetLife’s decision to uphold the termination. Because the dentist waited too long to file the lawsuit, the court dismissed the lawsuit without even considering whether the termination was improper.
These are just a few examples of things to be aware of if you have a MetLife policy or claim with MetLife. MetLife policies are not all identical and they are updated frequently. Your policy may or may not include the provisions mentioned above. If you are considering filing a disability claim, you should consult with an experienced disability insurance attorney to learn more about your policy and any potential issues related to your particular claim. And if your claim has been denied or terminated, you should talk with an attorney as soon as possible, to ensure that you do not forfeit your right to challenge the insurance company’s decision.
[1] https://investor.metlife.com/node/30501/html.
[2] https://www.metlife.com/support-and-manage/current-customers/individual-disability-insurance/.
[3] Abena v. Metro. Life Ins. Co., No. 06-C-495, 2007 WL 1575354, at *1 (E.D. Wis. May 29, 2007), aff’d, 544 F.3d 880 (7th Cir. 2008).
